Patient-Centered Outcomes Research (PCOR) helps people and their caregivers communicate and make informed health care decisions, allowing their voices to be heard in assessing the value of health care options. Comparative effectiveness research (CER) is designed to inform health-care decisions by providing evidence on the benefits and harms of different treatment options. The evidence is generated or synthesized from research studies that compare drugs, medical devices, or ways to deliver healthcare. This K24 award will extend the candidate's mentoring program that has allowed him to mentor 14 trainees and junior faculty during the prior cycle. Few clinical researchers in rheumatology are well trained to pursue PCOR or CER. Funding opportunities in these areas are likely to be 1 of few areas of growth in the federal research budget. The aims noted below will create an innovative set of databases ideal for PCOR and CER and will pursue CER studies with clinical relevance that provide excellent training opportunities. 1. To link an administrative claims database with an electronic medical record (EMR) database for three different rheumatic disease cohorts -- rheumatoid arthritis (RA), osteoarthritis (OA), and gout -- and then examine the agreement between databases. EMR databases have unique strengths and weaknesses that complement the strengths and weaknesses of administrative claims databases. There have been almost no prior attempts to link these two types of databases. We have already received approvals for the linkage, and data are currently being processed. Both databases share a unique identifier, allowing a deterministic linkage. We will assess 4 types of agreement in each cohort: agreement in underlying diagnosis, relevant drug exposures, covariates, and outcomes. 2. To conduct patient-centered outcomes research using the linked databases for these three cohorts. After linking the databases, we will conduct distinct patient-centered outcomes studies. In Aim 2a, we will examine the risk of fractures associated with oral glucocorticoids in RA. There have not been similar comparative effectiveness studies assessing whether patients with similar bone mineral density who use oral glucocorticoids are more likely to sustain fragility fractures. I Aim 2b, we will examine the role of TJR on all- cause mortality in moderate-severe hip and knee OA. TJR has clear short-term beneficial effects on pain and function, but it may also have long-term benefits, as has been suggested by at least one prior study. Prior work has had substantial limitations that can be overcome by the proposed linked database. Finally, Aim 2c will investigate the potential role of UALT on CVD outcomes. Strong epidemiologic data link hyperuricemia with CVD, but there have been no large studies examining whether treatments such as allopurinol, febuxostat, probenecid, or pegloticase may play a role in reducing CVD.